Ferhan Demirer Aydemir

Early mortality risk assessment is crucial for acute upper gastrointestinal bleeding (UGIB). This study sought to develop and internally validate a prediction model using age, pulse, urea, and albumin (APUA) components, and to assess the added value of admission lactate levels. This retrospective, single-center study included 700 adults presenting to the emergency department with suspected acute UGIB between 2018 and 2025, excluding confirmed variceal hemorrhage. We developed multivariable logistic regression models, both with and without lactate, using continuous APUA components to predict 30-day all-cause mortality. Complete-case analyses evaluated discrimination, calibration, and net benefit, with internal validation performed using 2,000 bootstrap resamples. Fifty-two patients (7.4%) died within 30 days. Lactate was independently associated with mortality (adjusted odds ratio per 1-mmol/L increase, 1.455; 95% confidence interval, 1.270–1.667). Adding lactate significantly increased the apparent area under the receiver operating characteristic curve (AUC) from 0.693 to 0.777 (AUC difference, 0.084; p = 0.003) and improved the optimism-corrected concordance statistic from 0.670 to 0.756. Calibration and overall predictive accuracy also improved, and decision curve analysis showed a higher net benefit across most evaluated thresholds. Furthermore, lactate enhanced the apparent discrimination of three established comparator scores. While the APUA-component model demonstrated modest discrimination, incorporating lactate significantly improved its predictive performance. Independent external validation is necessary before clinical implementation.

Amaç: Bu çalışma, yaşlı bireylerde kırılganlık durumunun; hemoglobin, albümin, lenfosit ve trombosit parametrelerinden oluşan HALP skoru ile, beslenme ve immünolojik durumu değerlendiren prognostik nutrisyonel indeks (PNI) arasındaki ilişkiyi incelemeyi amaçlamaktadır. Gereç ve Yöntemler: Çalışmaya 65 yaş ve üzeri toplam 205 katılımcı dâhil edildi. Kırılganlık değerlendirmesi için klinik kırılganlık ölçeği, yorgunluk (fatigue), direnç (resistance), ambulasyon (ambulation), hastalıklar (illnesses) ve kilo kaybı (loss of weight) bileşenlerini değerlendiren FRAIL ölçeği ve Edmonton Kırılganlık Ölçeği kullanıldı. Tüm katılımcıların HALP ve PNI skorları hesaplanarak istatistiksel analiz yapıldı. Bulgular: Tüm kırılganlık ölçeklerine göre kırılgan bireylerde HALP ve PNI skorları anlamlı olarak daha düşüktü (tüm karşılaştırmalar için p

Background: Frailty is a multidimensional syndrome associated with adverse outcomes in older adults. This study aimed to compare the predictive value of the FRAIL scale and the Clinical Frailty Scale (CFS) for 28-day mortality among critically ill geriatric patients. Methods: In this prospective cohort study conducted in a tertiary intensive care unit, all consecutive patients aged ≥65 years were assessed for frailty at intensive care unit admission using the FRAIL scale and the CFS. Logistic regression analysis was performed to identify independent associations with 28-day mortality. Receiver operating characteristic analyses with DeLong comparison and Kaplan–Meier survival analyses with log-rank testing were also performed. Results: Among 168 patients, 53% were male, and the median age was 77 years (IQR 70–82). The 28-day mortality rate was significantly higher in frail patients compared with non-frail patients according to both the FRAIL scale (36% vs. 16%, p = 0.005) and CFS (34% vs. 15%, p = 0.009). Agreement between the two tools was good ( κ = 0.75; 95% CI, 0.65–0.85). In multivariable analysis, frailty defined by the FRAIL scale remained independently associated with 28-day mortality (OR 2.41; 95% CI, 1.01–5.76; p = 0.048), whereas CFS-based frailty was not (OR 2.26; 95% CI, 0.91–5.63; p = 0.080). The AUROC values for total scores were 0.664 for the FRAIL scale and 0.700 for the CFS (DeLong p = 0.149); for dichotomized frailty status, AUROC values were 0.620 and 0.606, respectively (DeLong p = 0.595). Conclusion: Frailty at ICU admission is an important predictor of short-term mortality in older adults. The FRAIL scale demonstrated independent prognostic value in the primary adjusted model, while AUROC comparison did not show a statistically significant discrimination advantage over the CFS.

Aims: Home mechanical ventilation (HMV) is an essential component of long-term respiratory care. Patients and caregivers increasingly use online resources, including Artificial Intelligence (AI)-based chatbots, to obtain information regarding HMV. However, the readability, reliability, and quality of AI-generated information on HMV remain unclear. This study aimed to evaluate the readability, reliability, and quality of responses generated by ChatGPT, Gemini, and Perplexity for frequently asked questions about HMV. Methods: A cross-sectional content analysis was conducted in December 2025 using 47 high-interest HMV-related questions identified via Google Trends. Each question was entered verbatim into ChatGPT, Gemini, and Perplexity under standardized conditions. Readability was assessed using seven validated indices. Reliability was evaluated using the JAMA benchmark criteria and the modified DISCERN instrument, while overall educational quality was assessed using the Global Quality Score (GQS) and the Ensuring Quality Information for Patients (EQIP) tool. Non-parametric statistical tests were applied for inter-model comparisons. Results: All AI-generated responses significantly exceeded the recommended sixth-grade readability threshold across all indices (p

Background/Objectives: Home mechanical ventilation (HMV) has become an essential component of long-term respiratory support for patients with chronic respiratory failure. Despite the growing number of publications, the characteristics and citation patterns of the most influential studies have not been systematically evaluated. This study aimed to analyze the 50 most-cited publications on home mechanical ventilation indexed in the Web of Science Core Collection and explore citation patterns and potential associations with citation impact. Methods: This study was designed as a descriptive citation-based bibliometric analysis. A bibliometric analysis was performed using the Web of Science Core Collection. Publications related to home mechanical ventilation were ranked by total citation count, and the 50 most-cited articles were included. Extracted variables included publication year, total citations, citations per year, journal quartile, impact factor, index status, article type, topic category, geographic origin, and ventilation population category. Descriptive statistics were calculated. Group comparisons were performed using the Kruskal–Wallis and Mann–Whitney U tests, and correlations were evaluated with Spearman’s analysis. Funding status was summarized descriptively because funding was reported in only 8 studies. Results: The median total citation count was 15.5 (range: 1–118), and the median citations per year was 0.89 (range: 0.02–9.83). Most articles were published in Q1 journals and indexed in SCI-Expanded. Exploratory associations were observed between citation metrics and journal quartile/index status (p < 0.05). Articles published between 2005 and 2009 had the highest total citations, whereas those published after 2020 showed the highest citations per year. No association was observed with geographic origin. Conclusions: Distinct exploratory citation patterns were observed according to publication period, journal quartile, and index status. Bibliometric evaluation may help characterize the academic development and visibility of home mechanical ventilation research, but these findings should not be interpreted as confirmatory determinants of citation impact.

Introduction: Hyperglycaemia is common in intensive care unit (ICU) patients and blood glucose management practices likely vary, but there are limited contemporary data on ICU doctors' and nurses' preferences. Methods: We conducted an international online survey of ICU doctors and nurses. The 16‐question survey covered respondent characteristics, glucose management practices, perceived challenges with intermittent point of care (iPOC) glucose monitoring and continuous glucose monitoring (CGM), and preferences for a future trial on CGM versus usual care. Data were reported descriptively for all respondents and stratified by profession. Results: We received 1424 responses from 12 countries, of which 63% were from nurses. The overall response rate was 36% and the highest proportion of missing data for any question was 9%. Most respondents (92%) reported that their ICU had a glucose management protocol. The median reported insulin initiation threshold was blood glucose of 10 mmol/L. Long‐acting insulin was reported to be used occasionally by 68% of respondents. As needed pro re nata insulin was reported as most often given subcutaneously (43%) or intravenously (25%). Overall, 61% of ICU nurses reported concerns related to iPOC use versus 53% among ICU doctors (concerns among nurses versus doctors included risk of hypoglycaemia in 41% vs. 28%; risk of hyperglycaemia in 28% vs. 16%; patient discomfort in 26% vs. 27%). Overall, 75% of respondents never used CGM and 18% of ICU nurses reported concerns related to CGM use versus 22% of ICU doctors (accuracy and reliability in 14% vs. 18%; calibration and maintenance in 9% versus 16%; patient discomfort in 5% vs. 6%, respectively). Most respondents (89%) supported a randomised trial on CGM versus usual care in ICU and 68% preferred an intervention arm with a specific CGM‐treatment protocol. Conclusions: Glucose management preferences varied among ICU staff, particularly in the administration of as needed doses and long‐acting insulin. ICU nurses appeared more concerned about iPOC use than ICU doctors. The concerns about use of CGM appeared less common than concerns about iPOC. Most nurses and doctors would support a randomised trial on CGM versus usual care for glucose management in ICU and reported a preference for CGM to be used with a specific treatment protocol. Editorial Comment: This international survey highlights substantial professional differences and heterogeneity in ICU glucose management practices, particularly regarding as‐needed and long‐acting insulin use. Nurses expressed greater concern than doctors about intermittentpoint point‐of‐care glucose monitoring, especially the risks of hypoglycaemia and hyperglycaemia. Although continuous glucose monitoring was rarely used, it was viewed favourably overall, with broad support for a future protocolised randomised CGM trial.

How to cite this article: Aydemir FD. Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients. Indian J Crit Care Med 2026;30(3):260.